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Development of the healthcare system
THE beginnings of Oman's modernisation and development are relatively recent, starting in 1970 after the accession of Sultan Qaboos.
Prior to 1970, the state of the health system and infrastructure was very poor. There were only two small hospitals and a few dispensaries, and only 13 physicians each serving more than 50,000 people on average. As a result, morbidity and mortality rates were very high.
Oman's Ministry of Health (MOH) was established on Aug 22, 1970, and its role was to develop and implement health policies and plans; ensure the availability of quality health services across the country; improve population health and control of communicable diseases; develop maternal and child healthcare; provide health education for the population; and collaborate with other governmental and non-governmental sectors to improve health.
MOH is the main healthcare provider and is responsible for ensuring the availability of health policies and plans and monitoring their implementation, said Minister for Health Ahmed Mohammed Al Saidi. Other healthcare providers in the country include: the Armed Forces Medical Services (AFMS), Royal Oman Police Medical Services (ROPMS), Sultan Qaboos University Hospital (SQUH), Diwan Medical Services (Diwan MS), Petroleum Development Oman Medical Services (PDOMS), and other private sector providers.
It was only in the 1980s that basic healthcare infrastructure was able to make a meaningful contribution to the health development of the country. Since then. Oman has made remarkable achievements in the development of its healthcare system.
These achievements have been acknowledged by various international organisations, noted Dr Ahmed. For example, the United Nations Children's Fund (UNICEF) in its "Progress of Nations 1993" report ranked Oman first in the Middle East and North Africa Region (MENA) and second globally in terms of the percentage of reduction of Under-Five Mortality Rate (U5MR). Oman was able to achieve a two-thirds reduction in U5MR in just a decade, between 1981 and 1991.
A study commissioned by the Government of Oman, UNICEF and the World Health Organization (WHO) on health achievements in Oman also found that the country's decline in childhood mortality is one of the fastest recorded in the world. In its World Health Report 2000, WHO ranked the health system in Oman first among its 191 member states in terms of efficiency to improve health and eighth with regard to overall efficiency of the health system.
In addition, the World Health Report 2008 noted Oman's sustained investment in health services that has resulted in almost universal access to healthcare for Oman's population and better health seen in an increase in life expectancy at birth by 14 years and a 94 per cent reduction in the Under-Five Mortality Rate (U5MR) between the late 1970s and 2006.
"As at the end of 2015, the health sector has successfully reduced Infant Mortality Rate (IMR) and Under- Five Mortality Rate (U5MR) to 9.5 and 11.4 per 1,000 live births in 2015, compared with 118 and 181 in 1972 respectively," said Dr Ahmed.
He noted that high childhood immunisation coverage had been achieved by the late 1980s and has continued since then. The most advanced vaccines have been introduced as they were developed worldwide, including penta vaccine (diphtheria, pertusis, tetanus, hepatitis B and haemophilus influenza B), pneumococcal vaccine, and vaccination for all hepatitis B patients or carriers and everyone born since 1985.
These strategies have been successful in controlling communicable diseases especially in children, Dr Ahmed pointed out. The last case of poliomyelitis was reported in 1993; after 1987, only two cases of diphtheria have been reported (in 1991 and 1992); after 1991, only one case of tetanus neonatorum has been reported (in 1995); and no cases of measles has been reported in the last two years. Hepatitis cases have fallen by over 75%, compared with 2005.
The Sultanate has also witnessed a remarkable success story in malaria eradication. In 1975, almost every third individual in the population was infected with malaria (241,431 malaria cases were reported then). In 1990, there were almost 33,000 reported cases of malaria. Accordingly, in 1991, a malaria eradication programme was initiated. This resulted in a dramatic reduction in the number of cases, dropping to only 822 cases in 2015, and local transmission of the disease was considerably controlled to only four cases.
The bulk of Oman's healthcare is provided in facilities mainly owned and operated by the government, making up about 83.1 per cent of hospitals and about 92.5 per cent of hospital beds. The government covers about 89.8 per cent of total health expenditure, and individuals and families are effectively given free healthcare as out-of-pocket health expenditure comprises only 5.8 per cent of the total health expenditure.
The health system infrastructure has developed dramatically during the last decade. The number of hospitals increased to 70 in 2015 compared with 58 in 2005 with a 20 per cent increase in hospital beds. The number of primary healthcare centres run by MOH increased by 42 per cent in the same period.
This was accompanied by an increase in human resources as well, with the number of physicians and nurses doubling during this period. In 2015, there were 21.4 physicians and 46.3 nurses per 10,000 compared with 16.7 and 37 respectively in 2005.
Dr Ahmed, however, highlighted the fact that over the past two decades, the Sultanate has seen both a demographic as well as an epidemiological transition, with an ageing population and resultant change in disease profile to a predominance of non-communicable diseases and injuries.
"Accordingly, there was a great need to revisit the health system roles and have a proper long-term plan to face such challenges. So MOH developed its long-term vision - 'Health Vision 2050' - for developing and sustaining the health system," he said.
Health Vision 2050 extensively analysed the health status of the population and identified paths for development as well as opportunities for international players. The analysis showed, for example, that about 91.1 per cent of requirements from pharmaceuticals and surgical consumables, and all laboratory items, are met through imports, Dr Ahmed noted.
"There is a need to encourage and support local manufacturing of pharmaceuticals and consumables, and to invite major international pharmaceutical manufacturers and investors to set up production in Oman and/or to tie up with local Omani manufacturers for the production of medicines and vaccines if self-reliance is to be achieved," he emphasised.
The analysis also showed the need to strengthen tertiary care in the country. "We aim to have in the country tertiary care in hospitals of excellence to ensure the availability of tertiary care to patients close to their families. This would not only have financial implications, but social implications. It would reduce health expenditure made by patients seeking care outside the country and would provide care to patients near their homes and within their families," said Dr Ahmed.
He added: "We have plans to develop 'Medical Cities' that will provide such care, but we also invite international investments in such area. Oman has the potential to be a hub for medical tourism with such investments."
Going forward, there are plans to even out the balance between public healthcare facilities and private facilities. Currently, there are only 15 private hospitals with 582 hospital beds out of 70 hospitals and 6,468 hospital beds in the country.
"The policy of the government and MOH is to encourage investment by the private sector, both local and international, in the health sector. Health Vision 2050 has proposed a 50-50 partnership between the public and private health sector," said Dr Ahmed.
"MOH provides every possible technical advice and cooperation in setting up hospitals, clinics, and pharmaceuticals in the private sector. With regard to private hospitals, monitoring is done during the planning, the construction and the actual running stage in the form of technical protocol and the selection of doctors, nurses and paramedical staff."
The ninth Five-Year Health Development Plan (2016-2020) is the first (out of seven) health development plans to adopt and implement the vision and strategic action plans of Health Vision 2050 and will adopt results-based management techniques to specify achievable results, said Dr Ahmed.
"We aim for the health system development to help promote the competitiveness of Oman," the minister concluded.